Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2018; 24(26): 2878-2885
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2878
Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions
Jin Wang, Xiao-Nan Zhu, Lin-Lin Zhu, Wei Chen, Yi-Han Ma, Tao Gan, Jin-Lin Yang
Jin Wang, Xiao-Nan Zhu, Wei Chen, Yi-Han Ma, Tao Gan, Jin-Lin Yang, Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Jin Wang, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu 610041, Sichuan Province, China
Lin-Lin Zhu, Department of General Practice, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang J, Zhu LL, Gan T and Yang JL designed the research; Wang J, Zhu XN, Zhu LL, Chen W and Ma YH performed the research; Wang J, Zhu XN, Chen W and Ma YH collected the data; Wang J, Zhu LL and Gan T analyzed the data; Wang J, Zhu LL and Yang JL wrote the paper.
Supported by the Science and Technology Department of Sichuan Province for Scientific Research, No. 2015SZ0123.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the West China Hospital of Sichuan University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jin-Lin Yang, MD, PhD, Chief Doctor, Doctor, MHSc, Professor, Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, 37th Guoxue Alley, Chengdu 610041, Sichuan Province, China. mouse-577@163.com
Telephone: +86-28-85423326 Fax: +86-28-85423326
Received: March 16, 2018
Peer-review started: March 17, 2018
First decision: April 18, 2018
Revised: May 2, 2018
Accepted: June 9, 2018
Article in press: June 9, 2018
Published online: July 14, 2018
ARTICLE HIGHLIGHTS
Research background

Endoscopic submucosal dissection (ESD) is becoming the standard treatment for early gastrointestinal cancers, as it has a higher en bloc resection rate and a lower recurrence rate than endoscopic mucosal resection (EMR). However, when treating large mucosal lesions, ESD always faces many difficulties, such as multiple submucosal injections times, long procedure time, and low complete resection rate. To overcome these difficulties, a modified technique named endoscopic submucosal tunnel dissection (ESTD) has been proposed. Compared with ESD, ESTD could reduce the number of submucosal injections, shorten the procedure time, increase the resection speed, and reduce the injury of the muscular layer. However, there are no studies that verify the feasibility of ESTD in superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in a large sample.

Research motivation

To our knowledge, the present study is the largest sample research of ESTD technique to date, and our observation indicators are complete, the follow-up period is long, the results are credible, and there is strong reference significance in clinical work.

Research objectives

This study aims to evaluate the clinical outcomes of patients who underwent ESTD for ESCC and precancerous lesions.

Research methods

ESTD was performed in 289 patients with 311 lesions. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.

Research results

A total of 311 lesions were included. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate, postoperative bleeding rate, the perforation rate, and the postoperative infection rate were 6.43%, 1.61%, 1.93%, and 9.65%, respectively. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period.

Research conclusions

ESTD for ESCC and precancerous lesions is feasible and relatively safe, but the rates of esophageal stricture and positive margin are high for large mucosal lesions.

Research perspectives

The present study is a retrospective study to describe the general characteristics of ESTD. In the future, case control studies and prospective studies are considered necessary to evaluate further the feasibility and safety of ESTD for treating ESCC and precancerous lesions.